Conducts ongoing evaluation, analysis, and organization of all cap related procedures to accurately calculate monthly PCP and specialty provider capitation payments according to contractual terms.
Comprehends Provider contracts, is able to determine capitation terms and effectively incorporate changes and/or updates for configuration. Appropriately tests all changes for accuracy and implements into the cap process.
Identify and configure necessary additions, changes and deletions to new and existing configuration design as it relates to capitation.
Originates scheduling of pre cap/post cap calculations and capitation reports. Coordinates report extractions with Business Analyst and team members. Identifies variances and issues, analyzes and implements data for review, communicates issues and receives approvals from Executive Directors.
Ensures accuracy of data on Excel spreadsheets by verifying proper linking. Audits raw data, compares with worksheets to verify proper PCP/Specialty cap calculations. Generates and submits PCP/Specialty cap payment upload requests to Accounts Payable for processing.
Reconciles PCP/Specialty cap expense to general ledger. Generates cap related reports to perform PCP/Specialty audits, adjustments, check requests, analyses, research and special projects, as required.
Utilizes various computer programs to research provider, member and eligibility information.
High School. 2+ year’s college preferred with emphasis in business, finance or accounting.
Must be able to effectively communicate both verbally and in writing with all levels of management and to prioritize goals and responsibilities in a proactive manner.
Self motivated with excellent organizational, analytical and follow-up skills, accuracy, flexibility and attention to detail a must.
Working knowledge of Excel, Word, Outlook. Access experience a must.
An understanding of transaction systems and data flow highly desirable.
A Basic knowledge of ICD9 and CPT coding is beneficial.
10-key by touch
NAMM North America Medical Management - 5 months ago